A Comprehensive Model for Campus Death Postvention Death on a college campus is extremely disruptive and can have lasting effects on the community. Poor coordination of postvention efforts can result in delays and duplication of efforts, errors and misinformation, risk of liability, and public relations problems. An ecomap and a time-event flowchart are described for monitoring postvention.
By its very nature a crisis is sudden, unexpected, and traumatic, and produces chaotic responses in a social system. A crisis intervention plan recognizes that, although confusion reigns, specific actions can contain and lessen the impact. As an old Chinese adage advises, "You cannot prevent the birds of sorrow from flying over your head, but you can prevent them from building nests in your hair."
Sorrow is visited on college campuses at a disturbing rate, due to death resulting from illnesses, natural causes (e.g., heart disease), natural disasters, accidents, suicides, and homicides. The true incidence and causes of campus death remain unclear. However, colleges were not required to collect and report crime data until 1992, and even with this limitation, researchers estimate that high-risk crimes and deaths are still underreported due to unintentional cover-up, insufficient information to accurately categorize the event, or unwillingness of students to make a formal report (Bernard & Bernard, 1985; Schwartz, 1990). Some professionals believe the incidence has been chronically underreported by as much as 30% (Holinger, 1979; Schwartz, 1990).
Increased diversity (age, background, and risk factors) within college populations also counfounds accurate reporting and characterizing of deaths on campuses. At many colleges up to 40% of their student body comprises nontraditional students, who bring their cohort-related health risks onto campuses. Elderhostel programs and campus-sponsored programs for the off-campus community further diversify the risks, though a death in one of these groups may not have the widespread campus impact of the death of a resident student, a faculty member, or a staff member.
The mortality rate for traditional-age students is about 1 or 2 per 1,000 for the general population, although the rate may be slightly less for college populations (Crafts, 1985). Suicide is the third leading cause of death following accidents and homicide respectively (Berman & Jobes, 1991; Hipple, Cimbolic & Peterson, 1980; Zinner, 1985). On the main campus of the University of Rhode Island, for example, 45 students died between 1976 to 1984. Although this is an alarming number, approximately 6 deaths per year are within the expected mortality rate for a campus of 10,000 students (Crafts, 1985).
Campus deaths are not restricted to students. The former office partner of the first author was shot and killed at an Indiana college counseling center by a mentally ill student. This incident devastated the campus community for months and had a lasting effect on many of the victim's colleagues. In another case, a counseling faculty member suicided, causing peers and administration as much frustration, confusion, and grief as the students (Davis, Bates, & Velasquez, 1990).
Suicide is one of the more disruptive causes of death that can occur on campus. According to several surveys of college populations, 43%-65% of college students have admitted to some degree of suicidal ideation or behavior (depending on how it is defined), and as many as 23% report recent suicidal ideation during their college years (Bernard & Bernard, 1982; Lester, 1990; Mishara, Baker, & Mishara, 1976; Salmons & Harrington, 1984; Swenson, 1989).
Approximately 100,000 people under the age of 24 attempt to take their lives each year, with about 5,000 succeeding (Royte, 1994). The reported number of suicides for traditional age persons is estimated to be under reported by as much as 50 to 85% (Alcohol, Drug Abuse, and Mental Health Administration, 1989). Even more than suicide, homicide devastates the campus community. Violent crime on campus has risen steadily and a survey by the Chronicle of Higher Education found a 16% increase in the number of weapon-related arrests reported by college police (Lederman, 1994). Campus Homicide has an even more devastating effect than suicide on the campus community. In a survey of 698 colleges, Bansell, Maloy, and Sherrill (1990) reported 31 deaths due to murder. Violent death, especially the more horrific and senseless it is, can disrupt personal and campus functioning for a period ranging from months to a year (Berson, 1988; LaGrande, 1985; Sklar & Hartley, 1990).
Shelton and Sanders (1973) reported the mobilization of campus resources in response to a homicide and two other alleged assaults. They noted that natural grief reactions were complicated by insensitive and intrusive media representatives, extensive security patrolling, armed residents, parental overreaction, and generalized hysteria. Murders at Oregon State University in 1972 and the University of Florida in 1990 led large numbers of residential students to temporarily migrate off campus to safer quarters (Archer, 1992; Shelton & Saunders, 1973). Administrative involvement in crisis planning has come a long way since Hendrickson and Cameron reported in 1975 that 8% of college executives they surveyed believed student suicide was irrelevant to college and university administration. Nonetheless, in 1991, only 38% of colleges and universities surveyed had a written policy covering the operations for dealing with campus death, and minimal staff training was available (Wrenn, 1991). The absence of clear policy and practiced procedures can create a variety of problems that further complicate the grief response.
PROBLEMS DUE TO POOR COORDINATION
A campus death activates a response not only from student services professionals, but also from many other people on campus. At one college (Swenson, 1990), 23 departments or offices were involved in postvention following the death of a student, but they had not considered interdepartmental relationships in response to a crisis.
Poor coordination of response efforts can cause several problems: Unclear lines of authority and responsibility may result in duplicated efforts or even conflicting goals; problems in scheduling space for grief groups and other debriefings; and inappropriate contacts with survivors by multiple interveners unaware of other's involvement. Poor coordination and monitoring of assistance may produce delays in service delivery or may even cause at-risk groups to be overlooked. In one case involving a student suicide shooting, nearly a week elapsed before someone considered that custodial staff who had cleaned up the death scene might need support too. Uninformed responders may make tactless errors. For example, financial statements might be sent to deceased students for the next term, inappropriate humor (even for tension release) might be publicly expressed, and mourners might not be accurately informed about funerals or memorials. Without accurate and timely information, informal channels may promote rumoring. On one campus, rumors that a second murder had occurred led many students to arm themselves for self-protection.
Colleges may be liable for inappropriate action or inaction, or well-intentioned violations of client confidentiality. Failure to adequately protect students has led to an increase in successful lawsuits against colleges. For example, in 1984 Catholic University paid an estimated $700,000 to a student who had been raped and shot; in 1985 Howard University student was awarded $150,000 after being abducted and raped; and in 1988 George Washington University was sued for over $2 million after failing to protect or respond adequately to an assaulted student (Swisher, 1990).
Public relations problems can also emerge. Local media representatives may become intrusive and elicit displaced anger by students. For example, a group of students forcefully "escorted" reporters off grounds because the students felt that campus public relations representatives did not sufficiently control access to buildings. In addition, unofficial, contradictory, or outdated information may be released, and unavailable information may be viewed as stonewalling.
THE POSTVENTION MODEL
Several models and outlines of response strategies for campus postvention are available. Crafts (1985) has designed a thorough checklist of considerations in responding to death. Zinner (1985) presented a brief model of survivorship based on the directness of impact. Burling, Meeker, and Shanahan (1990) described a sequence of actions for a crisis management team. In addition, several authors proposed that a model should be community based, involve multiple stakeholders, progress through the stages of a crisis, and be clearly coordinated, usually by experienced counseling center professionals (Donohue, 1977; Corrazzini & May, 1985; Rickgarn, 1987; Trimble, 1990; Webb, 1986).
Colleges need a comprehensive model to account for all stakeholders (anyone affected directly or indirectly by the crisis) and their interrelationships, clarify tasks on a timeline, and provide a structure for discussing the plan and monitoring the postvention. This model is best described as a systems view of the campus community. It also recognizes that responders to victims may themselves become secondary victims of stress and require support. Given the organizational diversity of college administrative structures, this model is intended as a metamodel with which each campus can determine its own structure.
Usually initiatives for a postvention plan rests with the college counseling center, in coordination with the director or dean of students, or other chief student affairs officer with crisis intervention experience (Corrazzini & May, 1985; Trimble, 1990). Due to their central role, counseling professionals should have a clear understanding of and commitment to the plan before launching an initiative. This plan involves diverse stakeholders in the campus community, therefore it must be legitimized by the administration. The first step is to formulate a proposal to inform administrators of the need and request their support. The proposal should include data on the incidence of death on the campus, potential consequences of death for the campus community, problems resulting from poor coordination of postvention, and the postvention model. It may also include a listing of stakeholders who should attend an initial planning session. Planning session participants should have much of the same information provided to the administration: incidence, consequences, coordination problems, and proposal. The meeting participants should generate a list of additional stakeholders (anyone affected by the death, directly or indirectly, immediately or later). Each stakeholder should be identified in terms of proximity (campus, transitional, off campus), role or response, and task. The "ecomap" technique from family therapy (McPhatter, 1991) is a useful way for identifying the distribution of stakeholders (see Figure 1). The primary campus system and its subsystems (e.g., students, faculty, and staff) are at the core, with collateral community system stakeholders in the outlying area. The ecomap gives the planning group a visual summary of the many groups and resources involved in postvention.
[place Figure 1 about here]
The strategy for organizing this postvention plan is based on a time-event flowchart (see Figure 2) in which the responsibilities of each campus stakeholder are designated along a time line. This chart provides an overview of the plan over time and enables a crisis coordinator to track responses as postvention unfolds. Each intervening department can expand the flowchart to detail specific activities. The following steps can be used to construct the chart:
1. Identify each campus stakeholder involved in postvention. Examples of stakeholders include the crisis intervention coordinator, college president, and representatives of the counseling center, the campus security office, the student health center, and the residential life office.
2. Sequence the stakeholders down the left side of the flowchart based on their time of involvement with early responders at the top of the list, late responders toward the bottom.
3. Locate initial involvement according to the timeline at the top of the flowchart. Place a box at that location with a brief description of the specific tasks of the stakeholder department at that particular time. Add boxes with descriptions of subsequent tasks along the timeline as the postvention progresses. The timeline may begin with hourly segments, later changing to days and weeks. Monthly or even annual timelines should also be considered to cover delayed stress reactions and anniversary reactions.
4. Draw lines between boxes and stakeholders to show feedback loops and channels of communication. This demonstrates the interdependence of departments in the flow of information and clarity of response. Each stakeholder has a "supplier" who provides them with information, and a "customer" to whom they are next responsible.
5. The completed diagram should be examined for bottlenecks. At these junctions, stakeholders may need additional staffing, phone lines, delegation of subtasks, and so on. Gaps in services or lines of communication can also be identified and corrected.
6. This diagram becomes the master chart for coordinating and monitoring the postvention as it occurs. As with a large wall chart, storyboard, or project development Gantt chart, colored pins or notes may be attached as each stakeholder is activated and completes tasks during postvention.
7. Finally, place markers on the diagram to serve as checkpoints for monitoring the overall process or to designate key events. For example, a marker might be placed at the counseling center stakeholder after Day 3 to remind staff to conduct their own stress debriefing.
[place Figure 2 about here]
Using Figure 2 as an example, assume that the crisis intervention coordinator has received notification of a fatality. The coordinator activates the postvention process by notifying each stakeholder in turn down the list, starting with the counseling center, the campus security office, the student health service, and so on. When the counseling center is notified (usually through on-call staff), additional staff are called in. Some counselors provide support to immediate and secondary victims, remain alert to people who are reacting intensely, and consult on situation management. Secretaries notify additional counseling staff, access documents, and compile a list of high-risk persons for followup as they are identified. Within 24 hours, the counseling center professionals are assembled to provide support and consultation to students, faculty, and staff on campus. The coordinator's flowchart includes a schedule of times and locations for debriefings, grief groups, and other activities. By this time high the counseling center professionals have more clearly identified high risk students, referred them off-campus if necessary, and provided students with support to help attend classes if desired.
The flowchart has also been used to cross-reference student names or case identification with interventions or referrals so that high-risk people will not be overlooked. Within the first 24 hours the college attorney is contacted and updated on developments, issues, and questions. Though not shown in Figure 2, subsequent activities by the counseling center professionals would be recorded in each of the boxes as the situation unfolds over the next hours, days, and weeks. For example, by Day 2 or 3, the counseling center professionals will need to provide support and debriefing to each other as they personally react to the distress of the events. In the same way, the coordinator would note the sequence of activities for the other stakeholders as they engaged in their response duties.
Completing the flowchart, however, is not the end of the process. Once it is designed, the real task is testing it, revising the plan where necessary, and training staff in its use. The initial test is a trial run with the heads of the campus stakeholder offices. The flowchart can be placed where all can observe the steps as they emerge. A hypothetical case involving a death can be presented, and stakeholders can briefly describe their roles, tasks, and links to other stakeholders as the postvention progresses. At this point, duplication of effort, conflicting goals, and many of the other potential coordination problems noted earlier can be resolved. When the flowchart is completed, tested, and revised, the stakeholder representatives return to their departments and expand the model at that level. Their task is to train staff, develop new forms where needed, troubleshoot office procedures, and discuss the support and debriefing needs of staff during such a crisis. This part of the process is also a final opportunity to make changes in the overall plan. As campus and community resources change, the model can be updated, and future coordination problems can be minimized.
REFERENCES
Alcohol, Drug Abuse, and Mental Health Administration (1989). Report of the Secretary's Task Force on Youth Suicide. Volume 1: Overview and Recommendations. DHHS Publication No. ADM 89-1621. Washington, DC: Superintendent of Documents, US Government Printing Office.
Archer, J., Jr. (1992). Campus in crisis: Coping with fear and panic related to serial murders. Journal of Counseling and Development, 71, 96-100.
Bausell, C. R., Maloy, C. E., & Sherrill, J. M. (1990). The links among drugs, alcohol, and student crime: A research report. Towson, MD: Campus Violence Prevention Center, Towson State University.
Berman, A. L., & Jobes, D. A. (1991). Adolescent suicide: Assessment and intervention. Washington, DC: American Psychological Association.
Bernard, J. L., & Bernard, M. L. (1982). Factors related to suicidal behavior among college students and the impact of institutional response. Journal of College Student Personnel, 23, 409-413.
Berson, R. J. (1988). A bereavement group for college students. Journal for Group Psychotherapy, Psychodrama, and Sociometry, 41(3), 101-117.
Burling, P., Meeker, G., & Shanahan, E. J. (1990). Responding to campus crime: A guide for administrators. Chevy Chase, MD: United Educators Insurance Risk Retention Group, Inc.
Corrazzini, J. G., & May, T. M. (1985). The role of the counseling center in responding to student death. In E. S. Zinner (Ed.), Coping with death on campus (pp. 39-50). San Francisco: Jossey-Bass.
Crafts, R. (1985). Student affairs response to student death. In E. S. Zinner (Ed.), Coping with death on campus (pp. 29-38). San Francisco: Jossey-Bass.
Davis, J. M., Bates, C., & Velasquez, R. J. (1990). Faculty suicide: Guidelines for effective coping with a suicide in a counselor-training program. Counselor Education and Supervision, 29, 197-204.
Donohue, W. R. (1977). Student death: What do we do? NASPA Journal, 14(4), 29-32.
Gallagher, R. P. (1992). National survey of counseling center directors--1992. International Association of Counseling Services monograph, series no. 8b.
Hendrickson, S., & Cameron, C. A. (1975). Student suicide and college administrators: A perceptual gap. Journal of Higher Education, 46, 349-354. Hipple, J., Cimbolic, P., & Peterson, J. (1980). Student services response to suicide. Journal of College Student Personnel, 21, 457-458.
Holinger, P. C. (1979). Violent deaths among the young: Recent trends in suicide, homicides, and accidents. American Journal of Psychiatry, 36, 1144-1147.
LaGrande, L. E. (1985). College student loss and response. In E. S. Zinner (Ed.), Coping with death on campus (pp. 15-28). San Francisco: Jossey-Bass.
Lederman, D. (1994, February 4). Crime on the campuses: Increases reported in robberies and assaults; colleges remain confused over federal law. Chronicle of Higher Education, A31-41.
Lederman, D. (1994, March 9). Weapons on campus: Officials warn that colleges are not immune from the scourge of handguns. Chronicle of Higher Education, A33-34. Lester, D. (1990). Depression and suicide in college students and adolescents. Personality and Individual Differences, 11, 757-758.
McPhatter, A. R. (1991, January). Assessment revisited: A comprehensive approach to understanding family dynamics. Families to Society: The Journal of Contemporary Human Services, 11-21.
Mishara, B., Baker, H., & Mishara, T. (1976). The frequency of suicide attempts: A retrospective approach applied to college students. American Journal of Psychiatry, 133, 841-843.
Rickgarn, R. L. (1987). The death response team: Responding to the forgotten grievers. Journal of Counseling and Development, 66, 197-199.
Royte, E. (1994). They seemed so normal. Health, 8, 76-77. Salmons, P. H., & Harrington, R. (1984). Suicidal ideation in university students and other groups. International Journal of Social Psychiatry, 30, 201-205.
Schwartz, A. J. (1990). The epidemiology of suicide among students at colleges and universities in the United States. Special Issue: College student suicide. Journal of College Student Psychotherapy, 4(3-4), 25-44.
Shelton, J. L., & Sanders, R. S. (1973). Mental health intervention in a campus homicide. The Journal of the American College Health Association, 21, 346-350.
Sklar, F., & Hartley, S. F. (1990). Close friends as survivors: Bereavement patterns in a "hidden" population. Omega: Journal of Death and Dying, 21(2), 103-112.
Swenson, D. X. (1989). A survey of abuse-related behaviors of college students. Unpublished manuscript.
Swenson, D. X. (1990). A proposal for campus-wide crisis response plan. Unpublished manuscript.
Swenson, D. X., & Ginsberg, M. H. (1992, October). An integrated crisis intervention plan for campus death. Paper presented at the annual meeting of the Association for University and College Counseling Center Directors, Minneapolis, MN.
Swisher, K. (1990, February 24). Lawsuits increase as campus attacks do. The Washington Post, p. A1.
Trimble, R. W. (1990). Campus suicide prevention: Issues for the counseling center. Journal of College Student Psychotherapy, 4(3-4), 165-178.
Webb, N. B. (1986). Before and after suicide: A preventive outreach program for colleges. Suicide and Life Threatening Behavior, 16, 469-480.
Wrenn, R. L. (1991). College management of student death: A survey. Death Studies, 15, 395-402.
Zinner, E. S. (1985). Editor's notes. In E. S. Zinner (Ed.), Coping with death on campus (pp. 51-68). San Francisco: Jossey-Bass.